局部晚期食管鳞状细胞癌术后放疗和化疗的前瞻性研究  

A prospective comparison between surgery alone and postoperative chemoradiotherapy for locally advanced esophageal squamous cell carcinoma

作　　者：曹秀峰[1] 吕进[1] 朱斌[1] 安红银 王山 吴必超 纪律[1] 陶磊[1] 王冬冬[1] 

机构地区：[1]南京医科大学附属南京第一医院肿瘤中心外科,210006 [2]江苏省盐城市肿瘤医院放疗科 [3]江苏省盐城市肿瘤医院外科

出　　处：《中华肿瘤杂志》2010年第6期452-455,共4页Chinese Journal of Oncology

摘　　要：目的 评价局部晚期食管鳞状细胞癌（FSCC）手术后放射治疗和化疗的疗效.方法 将1997年1月至2004年6月间入院的158例ESCC（Ⅱ-Ⅲ期）患者随机分为术后放化疗组（78例）和单纯手术组（80例）.后经微调和排查,实际术后放化疗组为74例,单纯手术组为77例.对比两组患者的并发症发生率、局部复发率和远处转移率、生存率及无进展生存率.结果 患者平均随访45个月,术后放化疗组的并发症发生率与单纯手术组比较,差异无统计学意义（P〉0.05）.术后放化疗组局部复发和远处转移率低于单纯手术组（P〈0.05）.术后放化疗组的中位生存时间（53.5个月）与单纯手术组（37个月）比较,差异有统计学意义（P〈0.05）,两组的1年生存率比较,差异无统计学意义（P〉0.05）,但3、5和10年生存率比较,术后放化疗组优于单纯手术组（P〈0.05）.术后放化疗组的中位无进展生存期（46个月）与单纯手术组（34个月）比较,差异有统计学意义（P〈0.05）,两组1年无进展生存率比较,差异无统计学意义（P〉0.05）,但3、5和10年无进展生存率比较,术后放化疗组优于单纯手术组（P〈0.05）.结论 术后合理应用放化疗可有效提高局部晚期ESCC患者的无进展生存时间及长期生存率.Objective To investigate the role of postoperative chemoradiotherapy （ CRT） as a multimodality treatment option for locally advanced thoracic esophageal squamous cell carcinoma （ESCC） by a prospective comparison between surgery alone and postoperative CRT. Methods Using preoperative computed tomography （CT）-based staging criteria, 158 patients with ESCC （stage Ⅱ-Ⅲ） were enrolled in this prospective study. With informed consent, the patients were randomized into two groups： postoperative CRT （78 cases ） and surgery alone （S, 80 cases）. After a few minor adjustments to the enrolled patients, the actual patients of postoperative CRT group and S group were 74 cases and 77 cases, respectively. Comparison of the complications, local recurrence rate, distant metastasis rate, survival rate and progression-free survival in the two groups was carried out. Results With a median follow-up of 37.5 months, the 1-,3-,5-, 10-year overall survival （OS） rates were 91.0% , 62.8%,42.3%,24.4% and 87.5% , 51.3% , 33.8% , 12. 5% for the postoperative CRT and S arm, respectively. A significant difference in OS was detected between the two arms （P =0.0276）. There was a significant difference of progression-free survival （PFS） between the two arms （P=0.0136）. The local recurrence rates in the postoperative CRT group and S group were 14.9% and 36.4% , respectively （P〈0.05）. No significant difference was detected between the complications of the two groups （ P 〉 0. 05）. Toxicities of chemoradiotherapy in the postoperative CRT arm were moderate, which can be relieved rapidly by adequate therapy. Conclusion Rational application of postoperative chemoradiotherapy can provide a benefit in progression-free survival and overall survival in patients with locally advanced esophageal squamous cell carcinoma.

关 键 词：食管肿瘤 外科手术 药物疗法 放射疗法 

分 类 号：R735.1[医药卫生—肿瘤]